Coumadin vs. Lovenox after joint replacement

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Just wanting to know what everyones opinion was between coumadin vs. lovenox for ortho patients after total joint replacement?? What are your docs using?? Do they have a preference?? Why? Any side effects noted??

Specializes in trauma, ortho, burns, plastic surgery.

Lovenox is much safe! Coumadin need a good dosage and a PT/INR ratio done well.

Lovenox is expensive, Coumadin cheap

My opinion... advocate of patient nurse, looooool, patients need to know both of options and to choose by them self.

My experience more than 7 years in ortho..... lovenox ever... good dosage from begining, work well.

Less option coumadin on this type of surgeries.... but who I am.... I am just a nurse, loooooool!

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When i first started a few years ago my surgeon used lovenox for his knees for 14 days post-op and we used coumadin for his hip patients for 6 weeks post-op. We treat a big portion of medicare and DSHS pt's and we found compliance with lovenox for the knee pt had been poor do to the cost of the medication. Fortunately for us we have an anti-coag clinic in our building so we have gone to treating everyone across the board with coumadin. However the other surgeon is our practice still uses lovenox for the TKA's, and seems to do well with it.

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Specializes in ICU,ANTICOAG,ACUTE STROKE,EDU,RESEARCH.

I know this is an old post, but wanted to add my 2c anyway

Lovenox ,arixta and fragmin are all heparin.

Coumadin would be used to treat a DVT or PE as the patient is fully anticoagulated.

Anticoagulation with coumadin may be a cheap option regarding the drug cost- but the cost of good monitoring and cost of side effects have to be added into the equation.

LMWH can be given at a prophylactic dose or therapeutic dose ie for prevention of DVT in high risk patients (ie after lower limb joint replacement) or for treatment of DVT/PE. I wonder which ones these patients get?

I was also interested in the best practice evidence for use of coumadin versus LMWH after joint replacement.

Here in the UK we use Tinzaparin for prophylaxis, and would NEVER use coumadin unless patient was on it before surgery or was diagnosed with a PE. There is very strong evidence for this regime.

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Our docs feel that lovenox causes increased serous drainage from the wound and will NEVER (almost) use it. We use coumadin exclusively per a dosing protocol based on INR with the goal being 1.5-2.0. If the INR goes over 2.0, coumadin is held. A few docs use aspirin for THAs. In the event of a PE, patients are put on heparin until they are therapeutic and then take coumadin. As someone with experience, I would say I would rather take coumadin, even with the risk of side effects and monitoring over the lovenox. The lovenox injections were painful and annoying, and even with insurance were $15 for a 5 day supply versus coumadin which costs me $5 for a months supply. Our patients INR is monitored at home in conjunction with their visiting nurse follow-up care and home PT.

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Specializes in Ortho/Joint/Trauma.

In the past couple of years the AAOS have determined that Coumadin was a little overkill. So our facility switched to EC ASA 325mg BID. We have seen a few more patients with DVT and PE. We have also seen more cases of thrombocytopenia with Lovenox. Because of this we have 2 surgeons that use Arixtra. We still have the majority of our patients receiving ASA especially if they got a spinal injection for anesthesia. Of course those who came to us chronically on Coumadin...is d/c on coumadin.

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This is a great thread, glad it's being kept alive. About half our surgeons use Lovenox, half Coumadin, and one uses ASA (that one only does knees).

NurseTink, do you know of any data showing increases in DVT/PE with sole use of ASA? I'm very curious about this. If some surgeons are using ASA across the board (UNLESS pt is already on Coumadin or can't tolerate NSAIDS), I am curious why ASA seems to be the LEAST used, since it's cheap, OTC, requires no monitoring, and a large portion of adult patients are already taking 81-325mg QD for primary cardiovascular disease prevention.

I've wondered this for a while. Does anyone have any insights on this?

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I know this is an old post, but wanted to add my 2c anyway

Lovenox ,arixta and fragmin are all heparin.

Coumadin would be used to treat a DVT or PE as the patient is fully anticoagulated.

Anticoagulation with coumadin may be a cheap option regarding the drug cost- but the cost of good monitoring and cost of side effects have to be added into the equation.

LMWH can be given at a prophylactic dose or therapeutic dose ie for prevention of DVT in high risk patients (ie after lower limb joint replacement) or for treatment of DVT/PE. I wonder which ones these patients get?

I was also interested in the best practice evidence for use of coumadin versus LMWH after joint replacement.

Here in the UK we use Tinzaparin for prophylaxis, and would NEVER use coumadin unless patient was on it before surgery or was diagnosed with a PE. There is very strong evidence for this regime.

From a fortho rehab experince uk as well we use lmwh in my hopsital tinzaparin (Innohep)or enoxaparin (Lovenox and Clexane)if poor renal function for prophylaxis, or dvt, pe etc (also used on all our ortho/medical reahb.

warfarin is only used when proir initated by a heamolotoly.

i guess its different when most people are sent home with the all the dosses of lmwh as part of their treatment and

are either taught to adminster or have district nurses arranged.

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Specializes in ICU,ANTICOAG,ACUTE STROKE,EDU,RESEARCH.
This is a great thread, glad it's being kept alive. About half our surgeons use Lovenox, half Coumadin, and one uses ASA (that one only does knees).

NurseTink, do you know of any data showing increases in DVT/PE with sole use of ASA? I'm very curious about this. If some surgeons are using ASA across the board (UNLESS pt is already on Coumadin or can't tolerate NSAIDS), I am curious why ASA seems to be the LEAST used, since it's cheap, OTC, requires no monitoring, and a large portion of adult patients are already taking 81-325mg QD for primary cardiovascular disease prevention.

I've wondered this for a while. Does anyone have any insights on this?

I find this scary that there are ortho surgeons out there "doing their own thing"

I know that the evidence points to LMWH, not aspirin or coumadin.

Here is a link to the draft guidelines issued by the UK National Institute of clinical excellence draft guidelines

Page 17 talks about ortho patients.

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